Healthcare Provider Details

I. General information

NPI: 1669459418
Provider Name (Legal Business Name): MICHAEL P. ROMANOWSKY FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 RANGE RD
WINDHAM NH
03087-2098
US

IV. Provider business mailing address

PO BOX 9132
BROOKLINE MA
02446-9132
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-4119
  • Fax:
Mailing address:
  • Phone: 800-927-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNH

VIII. Authorized Official

Name: MICHAEL ROMANOWSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 800-927-0002